It is easy to understand the excitement about stem cell therapy in the treatment of injured or diseased tissue in the body. The prospect of using stem cells to heal injured or diseased tissues or modify symptoms in the future holds great promise for the development of orthopaedic care.
However, right now I share the opinions expressed in the leading orthopaedic journal, The Bone and Joint Journal in February of this year[1] when members of The Biologics Association warned against patients visiting rogue clinics around the world offering treatments using stem cell preparations. In line with the authors of the article, I urge anyone who is considering undergoing stem cell-based treatment to exercise the utmost caution in relation to any claims made. Currently, there is very little evidence to show such treatments are beneficial to patients and, in fact, biological procedures can be very risky.
[1] Bone Joint J 2020;102-B(2):148–154.
What are stem cells?
Stem cells are the cells from which all other cells that perform specialised functions in the body originate. Within the developing human body, stem cells divide to form more cells called daughter cells. These can then develop into new stem cells or become cells that perform a specialised function – such as brain cells or bone cells.
How might stem cells be used therapeutically?
Scientists are able to extract stem cells from embryos aged from three to five days old, as well as from perinatal cells (amniotic fluid and umbilical cord blood) and from most adult tissues where they exist in small quantities. Within a laboratory, they are able to cause the stem cells to form new daughter cells, which have the potential to develop into specialist cells.
In the future scientists hope that they might be able to use stem cells in a range of different ways, including to generate healthy cells that could be used to replace diseased cells, for example in osteoarthritis or spinal cord injuries. Stem cells might also have the potential to be grown into new tissue for use in transplants and regenerative medicine or to test new drugs for safety and effectiveness.
Patients urged to be cautious
While there are well-documented successes for some forms of cellular therapy (including blood transfusions and split-thickness skin grafts), widespread evidence of effectiveness is currently lacking, including for the regeneration of articular cartilage to treat diseases like arthritis.
For any new treatment to be offered to the public it is vital for it to be evidence-based and founded on tried and trusted research. Although research into the use of stem cell therapies in the treatment of osteoarthritis is ongoing and shows promise, the treatment is as yet largely unproven.
Clinics that are marketing “safe and effective stem cell treatments” are doing so without the clinical evidence to base it on. Such clinics may be offering expensive treatments that actually provide very little benefit and could even pose a risk to the health of vulnerable patients.
Guidelines from professional bodies
Guidelines from national and professional bodies such as the National Institute for Clinical Excellence (NICE) and the American Academy of Orthopaedic Surgeons (AAOS) currently do not recommend the routine use of stem cell therapies. They state that patients should only be offered stem cell treatment in the context of a formal research study.
Unsubstantiated claims
There are concerns, too, among reputable orthopaedic surgeons that clinics making unsubstantiated claims for this pioneering form of treatment threatens to undermine important research and could impede the development of stem cell therapy. As tempting as it is to be lulled by positive messages and enticing claims, it is important that any new treatment explains the risks and limitations as well as the risks.
If you are offered stem cell therapy, my advice is to avoid it unless it is part of a legitimate research study. In the future, once further research has been done and the treatments have been developed and refined, reputable orthopaedic consultants will be able to offer stem cell treatments and will provide a detailed picture of the risks and benefits, allowing you to make a fully informed choice.
If you are experiencing orthopaedic problems and would like to discuss the potential treatment options, contact Professor Joseph Queally for diagnostic and treatment advice.
